9. PSI Ethics Committee Member Agreement Template

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Ethics Committee Member Agreement

Ethics Committee Member Agreement

Introduction

This Agreement specifies the terms under which you, the undersigned (“the Advisor”) or (“the Member”), agree to serve as an Ethics Committee Member of [Company Name] ("the Organization" or “the client”), actively contributing to the mission of the Committee and adhering to the responsibilities outlined in Appendix B and in further detail in the Ethics Committee Charter [add link]

Term of Engagement

Effective Date: Your engagement commences on [Insert Effective Date] and will continue until [Insert End Date]. The initial term of this engagement shall be one year.

The Advisor will be considered an independent contractor for taxation purposes

No agency, partnership, joint venture, or employee-employer relationship is intended or created by this Agreement The Advisor will not be entitled to or eligible for any benefits that [Company Name] makes available to [Company Name]’s employees.

Time Requirements:

As detailed in the [Company Name] Ethics Committee Charter, the Committee meets [time requirement example: three hours monthly], with additional time allocated for tasks outside of meetings. The committee can adjust the frequency and duration of meetings to ensure that responsibilities are fulfilled effectively, but they must meet for at least one hour per month

Compensation and Reimbursement

Stipend Agreement: By selecting a stipend tier [see Appendix A] and signing this contract, the Advisor agrees to the stipend terms outlined [Company Name] affirms that this stipend is a payment for the terms of services and does not constitute an employer-employee relationship.

The Advisor has complete and sole responsibility for all applicable taxes on its compensation under this Agreement, including any withholding requirements, and for compliance with all applicable labor and employment requirements concerning the Advisor’s sole proprietorship or other form of business organization. [Company Name] shall have no obligation to, and shall not, withhold state or federal taxes from Advisor’s compensation or obtain any workers’ compensation, health, or other insurance of any kind on behalf of the Advisor

Yearly Stipend Amount:

Payment Frequency: Payment will be made for quarterly services in equal increments of the total stipend amount Payments will be issued as follows:

Oct-Dec term Payment issued by Jan 31st

Jan-March term Payment issued by April 30th

April-June term Payment issued by June 30th

July-Sept term Payment issued by Oct 31st

Forms: W-9 forms will be provided and requested to be filled out by the Advisor and submitted in time to enable the first payment.

Termination

Voluntary Resignation: You may terminate this agreement with 30 days' written notice to the Organization

Termination for Cause: The Organization may terminate this agreement at any time with immediate effect by providing written notice for breaches of the Code of Ethics or failure to meet responsibilities as laid out in the Ethics Committee Charter.

Confidentiality

Non-disclosure: You agree to keep confidential all information discussed or accessed through your Committee role, maintaining the integrity and privacy of sensitive matters, Confidential Information, or [Company Name] Intellectual Property.

The Advisor will use Confidential Information (defined below) only in connection with Advisor’s activities under this Agreement and will keep it confidential.

“Confidential Information” means all information, in any form, relating to [Company Name] and furnished to or obtained by the Advisor during the course of the Advisor's activities under this Agreement, including, without limitation, employee and student data, budget and other financial data, product plans and strategies, technical data and research, and know-how It does not include information which: (i) is or becomes generally available to the public other than as a result of a disclosure by the Advisor; (ii) was known by the Advisor prior to its being furnished to the Advisor by [Company Name]; (iii) is or becomes available to the Advisor on a nonconfidential basis from a source other than [Company Name]; or (iv) is independently developed by the Advisor All Confidential Information furnished under this Agreement is and will remain the property of [Company Name].

Obligation Post-Termination: Your confidentiality obligations persist beyond the termination of this agreement. Confidential information in written form or digital files should be returned to the Committee or organization within 30 days of termination, and any personal copies destroyed

Conflict of Interest

Immediate Disclosure: Conflicts of Interest include: (a) Financial Interest, any economic impact that a committee member or their immediate family may receive from a decision or action related to their role on the Ethics Committee, including ownership, compensation, intellectual property rights, research funding, or benefiting from financial decisions. (b) Private Interests, non-financial concerns, relationships, or affiliations that could influence a committee member's judgment or actions in their Committee role, such as close friendships, family relationships, membership in organizations, or positions of authority in other organizations. (c) Professional Interest, situations where a committee member's outside employment, professional affiliations, or career aspirations could influence their decisions or actions in their Committee role This includes employment or consulting relationships, leadership positions in professional associations, or receiving recognition from institutions affected by the Committee’s actions Any potential or actual conflicts of interest must be promptly disclosed to [Company Name] and documented per the Organization's policies and provided conflict of interest disclosure form Engage in prescribed actions to mitigate any identified conflicts of interest, ensuring impartiality in Committee decisions and responsibilities.

Ethical Misconduct Disclosure

Disclosure and Notice Procedure: Prior to executing this agreement, you must disclose to the [Company Name] Board of Directors and existing Ethics Committee Members any prior accusations, complaints, or charges of professional or ethical misconduct against you (regardless of the outcome or determination of such accusation). By signing this agreement, you agree that if there is any accusation against you at any point during your position on the Ethics Committee (whether or not related to [Company Name]), you will immediately provide the [Company Name] Board of Directors and existing Ethics Committee Members notice

Liability and Indemnification

Limited Liability: Notwithstanding any other provision in this Agreement, the Advisor shall not be liable for any issues, losses, or damages that arise to [Company Name] as a result of the implementation of the advising services or from the decisions and actions taken by the [Company Name] based on the advising services provided by the Advisor This includes but is not limited to, operational or strategic decisions made by [Company Name] that are based on or influenced by the advising services [Company Name] acknowledges and agrees that the Advisor is solely an Advisor and is not responsible for the execution or operational application of the strategies or recommendations provided [Company Name] agrees to hold harmless the Advisor against any claims, liabilities, or expenses arising from such issues, losses, or damages.

Mutual Consultant and Organization Indemnification: The Advisor and [Company Name] agree to indemnify, defend, and hold each other, [Company Name]’s Committee and Board Members, employees, contractors, agents, and other representatives, from and against any and all suits, judgments, costs, damages, claims, demands, actions, proceedings, expenses (including, without limitation, attorneys’ fees) or liabilities of any nature, that are asserted or

brought against, or are incurred by either party arising out of or relating to: (i) a claim that the material prepared by the Advisor and provided as part of the Services infringes, misappropriates, or otherwise violates any intellectual property right; (ii) death or injury of persons or damage or loss to property in any way arising out of the willful or negligent acts or omissions of the Advisor or [Company Name] and, its employees, or representatives; or (iii) breach of any obligations, representations, or warranties under this Agreement

General Provisions

Severability: The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision.

Obligation Limited to Client: The Advisor's obligations under this Agreement are solely to the Client, and no third party shall have any rights, including but not limited to any rights of enforcement, under this Agreement The Client acknowledges and agrees that the Advisor has no obligation to any third party in relation to the services provided under this Agreement.

No Waiver: The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement or the waiver of any breach of any of the terms and conditions of this Agreement shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred.

Governing Law: This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of [area of operation Example California].

Notices: Unless provided herein to the contrary, any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement.

Mediation: In the event of any dispute between the parties with respect to this Agreement or the Services (a “Dispute”), the parties shall attempt to resolve it promptly by good faith negotiation If the Dispute cannot be settled through negotiation, the parties agree to try in good faith to settle the Dispute by mediation lasting at least one day, before resorting to arbitration. The mediation process shall be confidential

Mandatory Arbitration: Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association, then in force and effect

Entire Agreement: This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement

Modification of Agreement: Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party.

Assignment of Rights: Each party's rights under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party

Counterparts: This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute but one and the same instrument. Electronic signatures shall have the same force and effect as an original.

Compliance with Laws: In performing under this Agreement, all applicable governmental laws, regulations, orders, and other rules of duly-constituted authority will be followed and complied with in all respects by both parties

Acknowledgment

By signing below, you confirm that you have read, understood, and agree to the terms outlined in this agreement and the Ethics Committee Charter.

Appendix A: Stipend

Intent: [Company Name] recognizes the essential role of Ethics Committee (EC) Members in shaping the organization’s ethical landscape As such, we acknowledge the necessity of providing some financial remuneration for the expertise and insight brought by each Advisor/Member

Stipend Structure Development: In alignment with [Company Name]'s commitment to financial equity and recognizing that each Member may have varying economic circumstances, the Organization has developed a Stipend structure. We strive to operate beyond traditional colonial capitalist frameworks while acknowledging the realities of financial needs in our society We seek a balanced approach that respects the diversity of financial experiences among Members.

Selection Process: Each Member is asked to self-select what tier of stipend they want They are asked to consider historical disparities across race, national history, class, etc, current financial situations, and the potential future earnings of Members, taking into account education level, career opportunities, and other relevant factors. [Company Name] respects each Member's choice and ensures a confidential process to determine the appropriate stipend tier for each individual

Stipend Distribution: Stipends are distributed quarterly, contingent upon active participation and fulfillment of committee responsibilities as defined in the Ethics Committee Charter Members who join or depart the Committee mid-quarter will receive compensation on a prorated basis, calculated based on the portion of the quarter during which they served Payments will be made according to the regular distribution schedule. The Organization commits to a transparent stipend determination and distribution process, providing each member the same stipend selection opportunity

Stipend Pool: As a young non-profit organization, we can commit [contribution amount Example $20,000] to the stipend pool for the Ethics Committee's first 12 months

Stipend Options: We invite Members to select from the following stipend tiers, reflecting a self-assessment of their financial standing and personal considerations The “Green Bottle” sliding scale image below may be useful in determining which tier to request.

1. Waiver of Stipend: For those in a position to voluntarily forego the stipend, allowing reallocation of funds to other Members who may have greater financial need

2 Nominal Stipend - $500/quarter ($2,000 Annually): Acknowledges social and cultural context of above-average historical and current access to means.

3 Standard Stipend - $1,000/quarter ($4,000 Annually): Acknowledges social and cultural context of average historical and current access to means

4 Flexible Stipend - Up to $2,500 Cap ($10,000 Annually): Acknowledges social and cultural context of systemically below-average historical and current access to means. Whatever remains of the stipend pool is divided, not exceeding the cap per Member

Customized Discussion: Members who wish to discuss their stipend to understand this model better or ascertain which option suits their financial situation are encouraged to engage in a confidential dialogue with the Organization’s designated officer before signing this Agreement.

Review: The Stipend Matrix and tiers will be reviewed annually or as necessary by [Company Name] leadership and the Board to ensure alignment with the Organization’s financial position and ethical commitments

Appendix B: Member Responsibilities

Responsibilities for the Ethics Committee

The responsibilities listed below provide an overview of the duties expected from the [Company Name] Ethics Committee Members The detailed responsibilities are laid out in the Ethics Committee Charter [add link]. These duties are subject to change based on the organization's evolving needs. Members are expected to remain flexible and adhere to the roles and responsibilities outlined in the most current version of the Ethics Committee Charter

The responsibilities of the ethics committee include:

a. Advisory Role

i. Ethical Guidance: Offer ongoing advice on ethical matters to different stakeholders within [Company Name], including leadership, staff, and board to support decision-making processes.

b. Grievance and Accountability Processes

i. Grievance Handling: Work with [Company Name] leadership to develop and oversee standardized procedures for addressing grievances, ensuring a fair and transparent process

ii. Restorative Accountability: Guide the organization in implementing restorative practices that address harm, facilitate reconciliation when possible, and promote the growth and learning of all involved in ethical breaches

c. Policy Review and Input

i. Examine and Provide Feedback: Regularly review [Company Name]'s policies, programs, and practices to ensure they reflect the organization's ethical commitments.

ii. Policy Development: Actively participate in the development of new policies to ensure they reflect high ethical standards

d. Code of Ethics Evolution

i. Continuous Improvement: Maintain and continuously improve [Company Name]'s Code of Ethics and Codes of Conduct to help ensure their relevance and effectiveness, incorporating feedback from stakeholders and adapting to new ethical challenges.

ii Implementation Monitoring: Monitor the effective implementation of the Code of Ethics across all levels of the organization

e. Programmatic Content and Methodologies Review

i. Program Content Review: Review and provide input on the development of programmatic content for ethical practices

ii. Program Methodologies Review: Review and provide input on the methodologies for teaching ethics within [Company Name]'s educational offerings

f. Ethical Training and Education

i Ethics Training: Lead the development and execution of ethics training for [Company Name]'s staff, emphasizing practical decision-making and ethical reasoning

ii. Awareness Campaigns: Initiate and oversee campaigns to promote ethical awareness and understanding throughout the organization

g. Consultation and Conflict Resolution

i Consultative Support: In collaboration with the Care Team, serve as a consultative body for addressing ethical dilemmas (i.e. decision points that need expert ethical guidance) and providing advice, aligned with [Company Name]’s values and ethics, to facilitate resolution

ii. Mediation: In collaboration with the Care Team, act as a mediator in conflicts where ethical considerations are central, proposing solutions that align with [Company Name]'s ethical values.

h. Ethical Monitoring and Reporting

i Ethical Audits: Conduct regular audits of [Company Name]'s practices to ensure compliance with ethical policies and standards

ii. Reporting: Provide comprehensive reports on the committee's activities, findings, and recommendations to the board and relevant stakeholders

i. Stakeholder Engagement

i Feedback Collection: Proactively engage with a broad spectrum of stakeholders to gather insights and perspectives on ethical matters.

ii Inclusion in Decision-Making: Ensure that stakeholder feedback is considered in the committee's deliberations and recommendations.

j. Strategic Planning and Goal Setting

i Strategic Priorities: Identify and establish the committee's strategic priorities and goals, ensuring they align with [Company Name]'s mission and values

ii Continuous Evaluation: Regularly assess the effectiveness of the committee's initiatives, adapting strategies to meet evolving ethical challenges and organizational needs

k. Other Roles

i Evolving Values: The committee may periodically review [Company Name]’s values and ethical principles and offer recommendations for changes to be made to be in greater alignment with the evolving ethical best practices in the field

ii. Media and Communications: The committee advises on ethical considerations in media releases and communications, helping ensure that [Company Name]'s public messages align with its ethical standards

iii. Human Resources: The committee contributes to the ethical evaluation of staff hiring and evaluations, infusing ethical considerations into HR processes

iv Admissions: For educational programs, the committee provides guidance on ethical criteria for student admissions, supporting fairness and integrity in selection processes

v. Continuous Learning: The committee is dedicated to continuous learning and staying updated with the latest developments in psychedelic care and ethics.

The Ethics Committee's primary responsibilities are to fulfill its advisory role to [Company Name], evolve the Code of Ethics and Codes of Conduct, address grievances and promote accountability, and review the program content and methodologies for alignment with ethical standards If the Committee Members conclude that the allocated time and resources are insufficient to fulfill all other duties adequately, they must prioritize their remaining responsibilities in a manner that best upholds [Company Name]'s ethical commitments.

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9. PSI Ethics Committee Member Agreement Template by Yuriy Blokhin - Issuu